| NPI | 1639212962 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10499) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA822) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2014-09-04 |