| NPI | 1053778191 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12112) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 53956) |
| Enumeration Date | 2016-01-20 |
| Last Update Date | 2024-10-28 |