| NPI | 1649446493 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 11114) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 01310) |
| Enumeration Date | 2008-05-01 |
| Last Update Date | 2023-04-04 |