| NPI | 1417245739 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10924) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 3114-23) |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2021-03-11 |