| NPI | 1184275794 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: MN 13360) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: WI 4850) |
| Enumeration Date | 2019-09-25 |
| Last Update Date | 2020-07-21 |