| NPI | 1174342562 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 8324-23) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0008847) |
| 363A00000X Physician Assistant (Licence: IL 085.011045) | |
| Enumeration Date | 2024-10-03 |
| Last Update Date | 2025-03-28 |