| NPI | 1306579818 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 14951) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 7954-23) |
| Enumeration Date | 2022-07-03 |
| Last Update Date | 2025-01-29 |