| NPI | 1639128630 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 1371-23) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: WI 1371-023) |
| 363A00000X Physician Assistant (Licence: WI 1371-023) | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2022-02-15 |