| NPI | 1366716102 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12809) |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics (Licence: ID OT-1120) |
| Enumeration Date | 2012-02-24 |
| Last Update Date | 2021-11-10 |