| NPI | 1770952095 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 5858) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2022-07-21 |