| NPI | 1114930096 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10722) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 4123) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2019-05-13 |