| NPI | 1790340552 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 13826) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 4669-23) |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2021-10-28 |