| NPI | 1760136683 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WI 7615) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IA 122436) |
| 363AM0700X Physician Assistant, Medical (Licence: MN 14680) | |
| Enumeration Date | 2022-02-09 |
| Last Update Date | 2024-01-04 |