| NPI | 1457937807 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 14924) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: WI 5808) | |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2024-07-23 |