| NPI | 1609062710 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10390) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-000540) |
| Enumeration Date | 2007-09-21 |
| Last Update Date | 2020-10-09 |