| NPI | 1386190817 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 13017) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C06465) |
| 363A00000X Physician Assistant (Licence: MI 5601007900) | |
| Enumeration Date | 2016-08-25 |
| Last Update Date | 2021-05-24 |