| NPI | 1124575485 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9109820) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 4701-23) |
| 363A00000X Physician Assistant (Licence: MN 13043) | |
| Enumeration Date | 2016-09-04 |
| Last Update Date | 2021-03-29 |