NPI | 1619505047 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 13753) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 5517) |
Enumeration Date | 2020-03-31 |
Last Update Date | 2021-09-15 |