| NPI | 1679817266 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL 9108410) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ND PAC0510) |
| Enumeration Date | 2012-11-20 |
| Last Update Date | 2022-09-20 |