| NPI | 1477987519 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 11409) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 1961) |
| Enumeration Date | 2013-08-26 |
| Last Update Date | 2021-10-13 |