| NPI | 1619290822 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 5740) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 10711) |
| Enumeration Date | 2010-03-03 |
| Last Update Date | 2017-10-16 |