| NPI | 1801878483 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10172) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 001623) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2020-08-24 |