| NPI | 1780630699 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WI 1974) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IA 1444) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2016-03-14 |