| NPI | 1770913071 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MN 11697) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA0003727) |
| 363A00000X Physician Assistant (Licence: MN 2159) | |
| Enumeration Date | 2013-11-22 |
| Last Update Date | 2015-12-26 |