| NPI | 1255512331 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 11995) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DC PA030513) |
| 363A00000X Physician Assistant (Licence: VA 0110002648) | |
| Enumeration Date | 2007-11-17 |
| Last Update Date | 2022-07-21 |