| NPI | 1205924156 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MN 12697) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IA 001738) |
| 363AM0700X Physician Assistant, Medical (Licence: CA PA22945) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2018-08-29 |