| NPI | 1164977468 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MN 12878) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WI 3826) |
| Enumeration Date | 2016-08-17 |
| Last Update Date | 2021-11-22 |