| NPI | 1356812838 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 15154) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MN 4141) |
| 133V00000X Dietitian, Registered (Licence: IA 089197) | |
| 363A00000X Physician Assistant (Licence: NE 3059) | |
| Enumeration Date | 2018-12-10 |
| Last Update Date | 2024-10-29 |