| NPI | 1427427731 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 13497) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601007543) |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2021-11-19 |