| NPI | 1528694221 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WI 5005) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 5005-23) |
| 363A00000X Physician Assistant (Licence: MN 13290) | |
| Enumeration Date | 2020-03-14 |
| Last Update Date | 2020-07-06 |