| NPI | 1215303904 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 13443) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601007500) |
| Enumeration Date | 2015-08-17 |
| Last Update Date | 2020-08-12 |