| NPI | 1710660311 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 15102) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 8132-23) |
| Enumeration Date | 2023-08-09 |
| Last Update Date | 2024-10-14 |