| NPI | 1619493657 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 13525) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 13525) |
| 363A00000X Physician Assistant (Licence: WI 4144-23) | |
| 363AM0700X Physician Assistant, Medical (Licence: WI 4144-23) | |
| 363AS0400X Physician Assistant, Surgical (Licence: WI 4144-23) | |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2024-01-19 |