| NPI | 1962198564 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ND PAC1165) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 14514) |
| Enumeration Date | 2023-04-17 |
| Last Update Date | 2025-08-21 |