| NPI | 1265405252 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 8843) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MN 363A00000X) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2012-07-13 |