| NPI | 1750330544 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 576-23) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WI 576-023) |
| 363AS0400X Physician Assistant, Surgical (Licence: WI 576-023) | |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2020-11-11 |