| NPI | 1992785190 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10079) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA1005038) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2022-08-16 |