| NPI | 1003180555 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 11079) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MN 1682) |
| 363A00000X Physician Assistant (Licence: WI 4312) | |
| 363AS0400X Physician Assistant, Surgical (Licence: WI 4312-23) | |
| Enumeration Date | 2012-03-01 |
| Last Update Date | 2021-04-27 |