| NPI | 1164705158 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10998) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MN 10998) |
| Enumeration Date | 2011-09-26 |
| Last Update Date | 2021-04-19 |