| NPI | 1063697449 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: MN 10975) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NM PA2007-0035) |
| Enumeration Date | 2008-01-04 |
| Last Update Date | 2015-04-28 |