| NPI | 1790736981 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 4254) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 12439) |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2022-07-21 |