| NPI | 1073631560 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MN 10587) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SD 0639) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2010-04-02 |