| NPI | 1871694463 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT 26604) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 1935) |
| 363A00000X Physician Assistant (Licence: WY 464) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2023-11-27 |