| NPI | 1366055063 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 13722) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601011077) |
| Enumeration Date | 2020-08-24 |
| Last Update Date | 2025-09-22 |