| NPI | 1053301036 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10717) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA16183) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2010-06-02 |