| NPI | 1194105551 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MN 13611) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SD 0977) |
| 363A00000X Physician Assistant (Licence: NM PA2019-0037) | |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2022-04-18 |