| NPI | 1942356944 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10212) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: WI 2089) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2012-05-08 |