| NPI | 1710328828 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 11389) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 4163-23) |
| Enumeration Date | 2013-07-17 |
| Last Update Date | 2019-05-10 |