| NPI | 1871594556 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 001805) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 12301) |
| 363A00000X Physician Assistant (Licence: WI 1823) | |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2024-06-12 |