| NPI | 1114592086 |
|---|---|
| Former Name | EMILY JOSEPHINE PETERSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 13539) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MN 13539) |
| Enumeration Date | 2021-05-24 |
| Last Update Date | 2023-01-12 |