| NPI | 1659749638 |
|---|---|
| Former Name | ELLEN HEAD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 13907) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MN 3580) |
| Enumeration Date | 2015-09-09 |
| Last Update Date | 2022-05-18 |