| NPI | 1861034563 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 13684) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 7617) |
| Enumeration Date | 2019-10-14 |
| Last Update Date | 2021-08-09 |