| NPI | 1558511212 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 14527) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WI 3249) |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2023-07-25 |