| NPI | 1104230606 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 11584) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 2079) |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2020-08-21 |