| NPI | 1164427548 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WI 1685) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WI 1685) |
| 363AM0700X Physician Assistant, Medical (Licence: IA 2124) | |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2015-07-10 |