| NPI | 1962749226 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ND PAC0561) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: ID PA-1039) |
| Enumeration Date | 2013-01-07 |
| Last Update Date | 2015-09-21 |