| NPI | 1508192295 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MN 10643) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA16292) |
| Enumeration Date | 2009-10-30 |
| Last Update Date | 2024-01-24 |