NPI | 1124792692 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 13842) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2021-08-06 |
Last Update Date | 2021-09-27 |