| NPI | 1780837641 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12383) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: ND 750) |
| Enumeration Date | 2008-10-23 |
| Last Update Date | 2018-05-22 |