| NPI | 1518396217 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 11467) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 1974) |
| Enumeration Date | 2013-11-04 |
| Last Update Date | 2020-08-24 |