| NPI | 1578966131 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12737) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: MN 12737) |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MN 2181) | |
| Enumeration Date | 2014-09-26 |
| Last Update Date | 2020-03-09 |