| NPI | 1790051357 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 14738) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: WI 3216) | |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2023-12-12 |