| NPI | 1619146453 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WI 2128-023) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WI 2128-023) |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2008-06-04 |