| NPI | 1114536844 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X (Licence: MN 13622) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MN 13662) |
| Enumeration Date | 2020-07-28 |
| Last Update Date | 2026-04-13 |