| NPI | 1811506470 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 13471) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN Pending) |
| 363A00000X Physician Assistant (Licence: WI 5203-23) | |
| Enumeration Date | 2020-07-29 |
| Last Update Date | 2020-09-03 |