| NPI | 1063671337 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: MN 10422) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 1131) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2019-09-24 |