| NPI | 1316941834 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 9613) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MN 9613) |
| 363AM0700X Physician Assistant, Medical (Licence: IA 1406) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2020-09-28 |