| NPI | 1609314269 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MN 12321) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA08653) |
| Enumeration Date | 2017-02-03 |
| Last Update Date | 2019-02-13 |