| NPI | 1114175783 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 11869) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA053444) |
| 363AM0700X Physician Assistant, Medical (Licence: CA PA22949) | |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2021-03-11 |