| 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 |