| NPI | 1639552706 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MN 14987) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MA PA8124) |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2024-08-14 |