| NPI | 1265986350 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12468) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: SD 1051) | |
| Enumeration Date | 2016-08-07 |
| Last Update Date | 2022-08-02 |