| NPI | 1861157901 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 122678) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 13900) |
| Enumeration Date | 2021-11-03 |
| Last Update Date | 2024-06-03 |