| NPI | 1083212625 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ND PAC0974) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 14228) |
| 363AM0700X Physician Assistant Medical (Licence: FL PA9113712) | |
| 363AM0700X Physician Assistant Medical (Licence: PA MA061930) | |
| Enumeration Date | 2020-10-15 |
| Last Update Date | 2022-10-03 |