| NPI | 1033669270 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MN 13345) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 001006602) |
| 363A00000X Physician Assistant (Licence: IL 085-006298) | |
| 363AM0700X Physician Assistant, Medical (Licence: WI 4327) | |
| Enumeration Date | 2016-10-12 |
| Last Update Date | 2020-05-07 |