| NPI | 1043554868 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 11222) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 11222) |
| 363A00000X Physician Assistant (Licence: WI 3284-23) | |
| 363AM0700X Physician Assistant Medical (Licence: CO PA.0004420) | |
| Enumeration Date | 2012-11-16 |
| Last Update Date | 2024-03-01 |