| NPI | 1720248172 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10432) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MN 1136) |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2024-01-11 |