| NPI | 1336474717 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 2511) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MI 5601006202) |
| 363AM0700X Physician Assistant Medical (Licence: WI 2511-23) | |
| Enumeration Date | 2009-10-02 |
| Last Update Date | 2024-03-18 |