| NPI | 1295754463 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MN 10114) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 2035) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2020-04-30 |