| NPI | 1073904496 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MN 11800) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 2212) |
| Enumeration Date | 2015-02-06 |
| Last Update Date | 2021-03-02 |