| NPI | 1245453612 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 3499-23) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 5993) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2020-11-17 |