| NPI | 1770735581 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10515) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MN 1214) |
| Enumeration Date | 2008-10-13 |
| Last Update Date | 2019-07-10 |