| NPI | 1902376585 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 4580-23) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: WI 4580-23) |
| 363AS0400X Physician Assistant Surgical (Licence: WI 4580-23) | |
| Enumeration Date | 2018-11-27 |
| Last Update Date | 2022-07-03 |