| NPI | 1174581540 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10103) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WI 3464) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2024-09-05 |