| NPI | 1487766820 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10413) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 1242) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-02-25 |