| NPI | 1386636553 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 9401) |
| 363AM0700X Physician Assistant Medical (Licence: MN 9401) | |
| 363AM0700X Physician Assistant Medical (Licence: WI 1954) | |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2024-04-04 |