| NPI | 1851621635 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10699) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MN 1088601) |
| Enumeration Date | 2009-12-30 |
| Last Update Date | 2013-10-09 |