| NPI | 1083296123 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 14256) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: CA PA62623) | |
| 363A00000X Physician Assistant (Licence: HI AMD-1241-0) | |
| Enumeration Date | 2021-04-27 |
| Last Update Date | 2023-08-10 |