| NPI | 1780383182 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 7289-23) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 14413) |
| Enumeration Date | 2023-02-24 |
| Last Update Date | 2024-01-30 |