| NPI | 1558841999 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 13834) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: RI PA01049) |
| 363AS0400X Physician Assistant, Surgical (Licence: MA PA6700) | |
| Enumeration Date | 2018-08-15 |
| Last Update Date | 2021-09-15 |