| NPI | 1588117352 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9115206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 12244) |
| 363AM0700X Physician Assistant, Medical (Licence: MN 12244) | |
| Enumeration Date | 2016-07-28 |
| Last Update Date | 2023-09-06 |