| NPI | 1013630342 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MN 15062) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WI 8067) |
| Enumeration Date | 2022-09-21 |
| Last Update Date | 2024-11-18 |