| NPI | 1114286911 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 11159) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 2983-23) |
| 363AS0400X Physician Assistant, Surgical (Licence: WI 2983-23) | |
| 363AS0400X Physician Assistant, Surgical (Licence: MN 11159) | |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2021-09-28 |