| NPI | 1942219647 |
|---|---|
| Doing Business As | |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 753-023) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 3124-28) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2021-11-24 |