| NPI | 1962607143 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: MN 9495) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 9495) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2007-12-31 |