| NPI | 1295911550 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 2214) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IA 2032) |
| 363AM0700X Physician Assistant, Medical (Licence: WI 2214) | |
| Enumeration Date | 2008-01-17 |
| Last Update Date | 2021-04-23 |