| NPI | 1760670210 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MN MN 10564) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9104324) |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2012-07-10 |