| NPI | 1548272560 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 11476) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA16950) |
| 363A00000X Physician Assistant (Licence: AZ 3625) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2020-08-24 |