| NPI | 1154024586 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 124548) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 14257) |
| Enumeration Date | 2023-03-24 |
| Last Update Date | 2024-05-23 |