| NPI | 1659890762 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12527) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 7695-23) |
| Enumeration Date | 2017-09-11 |
| Last Update Date | 2025-01-28 |