| NPI | 1174760003 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 10681) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 001971) |
| 363AM0700X Physician Assistant, Medical (Licence: MN 10681) | |
| Enumeration Date | 2009-01-14 |
| Last Update Date | 2015-09-22 |