| NPI | 1619383684 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: MN 11598) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MN 2096) |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2015-10-26 |