| NPI | 1811987118 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MN 11187) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 11187) |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2019-09-10 |