| NPI | 1649467697 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10574) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 2195-023) |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2014-12-30 |