| NPI | 1063412112 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: MN 10090) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: WI 1500-23) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2015-06-30 |