| NPI | 1730626599 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT 80310) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 12356) |
| Enumeration Date | 2017-01-31 |
| Last Update Date | 2021-11-11 |