| NPI | 1295144236 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 11957) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 3342-23) |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2017-10-05 |