| NPI | 1083166862 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12698) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA5953) |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2020-01-03 |