| NPI | 1659516847 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MN 10700) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA 9104763) |
| Enumeration Date | 2008-12-03 |
| Last Update Date | 2023-05-11 |