| NPI | 1063997583 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 9665) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 13025) |
| Enumeration Date | 2018-10-01 |
| Last Update Date | 2023-06-30 |