| NPI | 1386817203 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-01260) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NC MN1751177) |
| Enumeration Date | 2008-04-11 |
| Last Update Date | 2021-08-10 |