| NPI | 1740277896 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10547) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 085-002027) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2020-08-21 |