| 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 |