| NPI | 1396741823 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WI 4322) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MN 9566) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2018-07-24 |