| NPI | 1679894299 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10749) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ND TC) |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2012-07-24 |