| NPI | 1225032717 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 9095) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: SD 0590) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2020-05-22 |