| NPI | 1639583693 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MN 11630) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WI 3385-23) |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2021-01-21 |