NPI | 1770139420 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 13050) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 7894) |
363AM0700X Physician Assistant, Medical (Licence: MN 13050) | |
Enumeration Date | 2019-08-16 |
Last Update Date | 2024-09-30 |