| NPI | 1558797522 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 4668) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA61140376) |
| 363AM0700X Physician Assistant, Medical (Licence: VA 0110004368) | |
| Enumeration Date | 2013-09-22 |
| Last Update Date | 2023-08-15 |