| NPI | 1518936517 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 9587) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: MN 9587) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2020-11-04 |