| NPI | 1861959306 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 13466) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 5184-23) |
| 363AM0700X Physician Assistant, Medical (Licence: WI 5184) | |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2021-09-09 |