| NPI | 1790494110 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: ND 12044697) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ND 12044697) |
| Enumeration Date | 2022-11-15 |
| Last Update Date | 2025-04-30 |