| NPI | 1720234800 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WI 4357) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA04922) |
| 363A00000X Physician Assistant (Licence: MT 41592) | |
| Enumeration Date | 2008-08-08 |
| Last Update Date | 2020-01-30 |