| NPI | 1245318393 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 002303) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 855-023) |
| 363AM0700X Physician Assistant Medical (Licence: WI 855-023) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2022-09-12 |