| NPI | 1619378585 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 3480) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 11699) |
| Enumeration Date | 2014-09-10 |
| Last Update Date | 2021-07-15 |