| NPI | 1629245766 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10486) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SD 0678) |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2008-09-18 |