| NPI | 1235206525 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MN 57321) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MN 107233) |
| 363AM0700X Physician Assistant, Medical (Licence: CA 15822) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2021-12-22 |