| NPI | 1689310500 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110011061) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 14120) |
| Enumeration Date | 2022-05-12 |
| Last Update Date | 2026-01-27 |