| NPI | 1043579121 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 11416) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 11214) |
| Enumeration Date | 2012-05-10 |
| Last Update Date | 2025-12-23 |