| NPI | 1083257612 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA217282) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 13208) |
| Enumeration Date | 2019-10-27 |
| Last Update Date | 2024-02-22 |