| NPI | 1649638883 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12027) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IA 083328) |
| Enumeration Date | 2016-02-02 |
| Last Update Date | 2023-03-08 |