| NPI | 1871994095 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 122300000X Dentist (Licence: MN 1411674742) |
| Enumeration Date | 2014-09-08 |
| Last Update Date | 2022-07-21 |