| NPI | 1104852094 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10495) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 6669778-1206) |
| 363A00000X Physician Assistant (Licence: AZ 3127) | |
| 363A00000X Physician Assistant (Licence: OK 1414) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2018-10-19 |