| NPI | 1144750423 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 14226) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 4295-23) |
| 363AS0400X Physician Assistant, Surgical (Licence: WI 4295) | |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2022-11-16 |