| NPI | 1275508137 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 9961) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 1911) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2021-04-07 |