| NPI | 1770909749 |
|---|---|
| Other Name | NICOLE ELIZABETH LARSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MN 11514) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 11514) |
| Enumeration Date | 2014-03-13 |
| Last Update Date | 2014-04-01 |