| NPI | 1679738819 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MN 10441) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WI 4301) |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2024-05-06 |