| NPI | 1649718453 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12340) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MN 12340) |
| Enumeration Date | 2017-02-01 |
| Last Update Date | 2025-10-31 |