| NPI | 1831522424 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 11386) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 3161 - 23) |
| Enumeration Date | 2013-08-19 |
| Last Update Date | 2013-11-23 |