| NPI | 1265540710 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 9397) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085002224) |
| 363A00000X Physician Assistant (Licence: IA 079329) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2015-09-22 |