| NPI | 1750665576 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MN 10996) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MN 1630) |
| Enumeration Date | 2011-09-29 |
| Last Update Date | 2020-09-18 |