| NPI | 1710912993 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10456) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110001016) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2015-11-30 |