| NPI | 1669633210 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 2280) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WI 2280-23) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2020-12-28 |