| NPI | 1205120821 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SD 1376) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 11007) |
| 363AS0400X Physician Assistant, Surgical (Licence: MN 11007) | |
| Enumeration Date | 2011-05-31 |
| Last Update Date | 2025-05-16 |