| NPI | 1821423781 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MN 12733) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IL 085004766) |
| 363AM0700X Physician Assistant, Medical (Licence: WI 3196) | |
| Enumeration Date | 2013-09-11 |
| Last Update Date | 2018-08-31 |