| NPI | 1235104928 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 961) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 9382) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2013-02-19 |