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 |