| NPI | 1306085956 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA159754) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 10540) |
| 363A00000X Physician Assistant (Licence: MN 1248) | |
| Enumeration Date | 2009-02-05 |
| Last Update Date | 2020-10-19 |