| NPI | 1124487913 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MN 12049) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0005023) |
| 363A00000X Physician Assistant (Licence: MN 12049) | |
| Enumeration Date | 2016-02-22 |
| Last Update Date | 2024-07-10 |