| NPI | 1073919205 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 11731) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 3448) |
| Enumeration Date | 2014-11-17 |
| Last Update Date | 2022-03-28 |