| NPI | 1053468074 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110008350) | 
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MN 10078) | 
| Enumeration Date | 2007-01-04 | 
| Last Update Date | 2025-09-15 |