| NPI | 1558657064 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12780) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA054902) |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2025-12-22 |