| NPI | 1871510735 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ND PAC0168) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 9215) |
| 363AM0700X Physician Assistant, Medical (Licence: MN 9215) | |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2018-06-27 |