| NPI | 1104399849 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9114358) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 12918) |
| Enumeration Date | 2019-01-04 |
| Last Update Date | 2023-12-21 |