| NPI | 1902514524 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 15348) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AK 204903) |
| Enumeration Date | 2022-11-14 |
| Last Update Date | 2025-08-14 |