| NPI | 1417429812 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 4632) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 12975) |
| 363AS0400X Physician Assistant, Surgical (Licence: WI 4632) | |
| Enumeration Date | 2018-12-23 |
| Last Update Date | 2026-08-17 |