| NPI | 1194701102 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 9323) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MN 9323) |
| 363AS0400X Physician Assistant, Surgical (Licence: WI 1951) | |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2022-05-19 |