| NPI | 1508288374 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12106) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 2665) |
| Enumeration Date | 2014-01-14 |
| Last Update Date | 2020-08-24 |