| NPI | 1588296453 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 13796) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110007098) |
| Enumeration Date | 2020-02-10 |
| Last Update Date | 2024-02-14 |