| NPI | 1932189636 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 11636) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 1640) |
| 363A00000X Physician Assistant (Licence: WI 2455) | |
| 363AS0400X Physician Assistant, Surgical (Licence: MI 5601002403) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2022-05-26 |