| NPI | 1194809400 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10589) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IL 085-002505) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2009-08-13 |