| NPI | 1255403572 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 9492) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 2804) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2009-01-29 |