| NPI | 1700882149 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 432) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: WI 432) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2021-10-11 |