| NPI | 1710116892 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10930) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 002009) |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2013-10-25 |