| NPI | 1861849382 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 2477) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AS0400X Physician Assistant, Surgical (Licence: MN 2477) | |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2020-11-25 |