| NPI | 1629031182 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 9687) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 1840-23) |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2018-10-05 |