| NPI | 1760138853 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 8331) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2022031602) |
| Enumeration Date | 2022-02-27 |
| Last Update Date | 2026-02-18 |