| NPI | 1417364597 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12298) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IA 074633) |
| 363AM0700X Physician Assistant, Medical (Licence: MN 12298) | |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2021-04-09 |