| NPI | 1801652706 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 15672) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 880023) |
| Enumeration Date | 2024-02-27 |
| Last Update Date | 2026-04-17 |