| NPI | 1710923594 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: MN 9179) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: SD 1019) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2016-10-31 |