| NPI | 1467407379 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 11609) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 01107) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2016-09-02 |