| NPI | 1851377444 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 2702) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 1334) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2010-11-30 |