| NPI | 1851857627 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT MED-PAC-LIC-123945) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 12923) |
| 363AM0700X Physician Assistant Medical (Licence: MN 12923) | |
| Enumeration Date | 2019-02-15 |
| Last Update Date | 2023-08-09 |