| NPI | 1093112369 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NE 2018) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MN 11783) |
| 363AM0700X Physician Assistant, Medical (Licence: IA 081953) | |
| Enumeration Date | 2014-12-02 |
| Last Update Date | 2016-05-26 |