| NPI | 1457310591 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WI 809) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 029367) |
| Enumeration Date | 2006-03-18 |
| Last Update Date | 2023-05-31 |