| NPI | 1073648044 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10236) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 935-023) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2018-12-18 |