| NPI | 1811974801 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MN 9808) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WI 1454-023) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2020-06-11 |