| NPI | 1376806133 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 11145) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-06011) |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2023-03-29 |