| NPI | 1265143275 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 8037) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| 363A00000X Physician Assistant (Licence: AZ 9977) | |
| Enumeration Date | 2022-12-09 |
| Last Update Date | 2025-01-28 |