| NPI | 1619722329 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 1217228) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 1217228) |
| Enumeration Date | 2024-04-17 |
| Last Update Date | 2024-04-17 |