| NPI | 1073042149 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 10449) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 12469) |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2025-09-17 |