NPI | 1134872591 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 1193255) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2022-01-26 |
Last Update Date | 2022-08-15 |