| NPI | 1134509797 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 12762100-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: MN 11886) | |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2022-06-09 |