| NPI | 1639416522 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 11250) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 3353-23) |
| Enumeration Date | 2013-01-11 |
| Last Update Date | 2018-10-11 |