| NPI | 1932184769 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MN 10110) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 1427) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2022-05-31 |