| NPI | 1598921108 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 11353) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085004067) |
| 363A00000X Physician Assistant (Licence: NY 012648) | |
| Enumeration Date | 2008-08-03 |
| Last Update Date | 2013-10-04 |