| NPI | 1205117751 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 4944) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 12040) |
| Enumeration Date | 2011-08-29 |
| Last Update Date | 2021-08-25 |