| NPI | 1407215718 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 7789) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 4155) |
| Enumeration Date | 2016-02-15 |
| Last Update Date | 2021-03-02 |