| NPI | 1619658242 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 14657) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 7635) |
| Enumeration Date | 2023-07-27 |
| Last Update Date | 2023-10-04 |