| NPI | 1619619822 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 5786) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 14843) |
| Enumeration Date | 2022-04-08 |
| Last Update Date | 2024-05-16 |