| NPI | 1780150219 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA061908) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 12837) |
| 207P00000X Emergency Medicine (Licence: MN 12837) | |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2020-10-06 |