| NPI | 1548230642 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WI 2881) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 10005) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2015-05-19 |