| NPI | 1972052371 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 3989-23) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9109846) |
| Enumeration Date | 2016-09-26 |
| Last Update Date | 2020-12-29 |