| NPI | 1588920201 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2021020067) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 11096) |
| 363A00000X Physician Assistant (Licence: MN 1694) | |
| Enumeration Date | 2012-04-06 |
| Last Update Date | 2021-07-29 |