| NPI | 1063489391 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10362) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MS PA-051) |
| Enumeration Date | 2006-03-06 |
| Last Update Date | 2020-08-24 |