| NPI | 1184809907 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 11136) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA05991) |
| 363AS0400X Physician Assistant, Surgical (Licence: TX pa05991) | |
| 363AS0400X Physician Assistant, Surgical (Licence: IL 085003026) | |
| Enumeration Date | 2007-12-31 |
| Last Update Date | 2021-03-05 |