| NPI | 1629382940 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: HI AMD-838) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MN 10804) |
| 363AS0400X Physician Assistant, Surgical (Licence: MN 10804) | |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2019-01-21 |