| NPI | 1902275613 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 8488) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 11994) |
| Enumeration Date | 2015-09-23 |
| Last Update Date | 2025-08-22 |