| NPI | 1275834640 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10834) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 2679-023) |
| Enumeration Date | 2010-11-16 |
| Last Update Date | 2021-05-10 |