| NPI | 1891251690 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 13482) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.005903RX) |
| Enumeration Date | 2019-02-17 |
| Last Update Date | 2021-02-01 |