| NPI | 1467123166 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 15175) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601011913) |
| Enumeration Date | 2021-09-22 |
| Last Update Date | 2025-01-09 |