| NPI | 1124072889 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WI 1289-23) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 978) |
| 363AM0700X Physician Assistant, Medical (Licence: VA 0110001577) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2015-06-02 |