| NPI | 1457696379 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 4950-23) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 4951) |
| Enumeration Date | 2012-12-04 |
| Last Update Date | 2020-01-07 |