| NPI | 1568098812 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 13760) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MO 2020009645) |
| Enumeration Date | 2020-03-19 |
| Last Update Date | 2021-11-08 |