| NPI | 1609918499 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10648) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-00645) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2011-08-26 |