| NPI | 1245221860 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 11014) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA17779) |
| 363A00000X Physician Assistant (Licence: NV PA900) | |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2021-03-11 |