| NPI | 1053411157 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 11431) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX pa04432) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2016-01-11 |