| NPI | 1659822815 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 391523) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2016-10-21 |
| Last Update Date | 2021-01-22 |