| NPI | 1063674109 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 11223) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 085002037) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2024-05-03 |