| NPI | 1740539568 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 3018-23) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 11129) |
| Enumeration Date | 2012-09-07 |
| Last Update Date | 2012-09-07 |