| NPI | 1174523195 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 4132) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 104045) |
| 363A00000X Physician Assistant (Licence: MN 13911) | |
| Enumeration Date | 2005-08-01 |
| Last Update Date | 2023-04-12 |