| NPI | 1801552047 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MN 13708) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 21169160625) |
| 363A00000X Physician Assistant (Licence: MN 13708) | |
| Enumeration Date | 2021-11-11 |
| Last Update Date | 2023-12-22 |