| NPI | 1659361244 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: ND PAC0333) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MN 815) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2007-07-08 |