| NPI | 1730150053 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 9859) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 9174) |
| 363AM0700X Physician Assistant, Medical (Licence: MN 9859) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2023-05-02 |