| NPI | 1063149557 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 14133) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 7079) |
| Enumeration Date | 2022-08-04 |
| Last Update Date | 2022-10-04 |