| NPI | 1730695412 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ND PAC0794) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 105968801206) |
| 363A00000X Physician Assistant (Licence: MN 13106) | |
| 363A00000X Physician Assistant (Licence: AK 141585) | |
| Enumeration Date | 2017-12-18 |
| Last Update Date | 2020-04-02 |