| NPI | 1689920225 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 3645-23) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 11117) |
| Enumeration Date | 2012-08-01 |
| Last Update Date | 2015-12-12 |