| NPI | 1558791145 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12748) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MN 3289) |
| Enumeration Date | 2013-11-18 |
| Last Update Date | 2018-08-03 |