| NPI | 1831640127 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12855) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA5945) |
| Enumeration Date | 2016-10-20 |
| Last Update Date | 2019-01-28 |