| NPI | 1316703374 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 15716) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 8901-23) |
| Enumeration Date | 2024-02-26 |
| Last Update Date | 2026-05-07 |