| NPI | 1689684292 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10173) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 079368) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2015-10-21 |