| NPI | 1063097483 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 114078) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 13741) |
| 363AM0700X Physician Assistant, Medical (Licence: IA 114078) | |
| 363AS0400X Physician Assistant, Surgical (Licence: IA 114078) | |
| Enumeration Date | 2021-03-17 |
| Last Update Date | 2023-12-19 |