| NPI | 1376979252 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 13962) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MN 3277) |
| Enumeration Date | 2013-09-23 |
| Last Update Date | 2022-02-17 |