| NPI | 1912558651 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 13090) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 490423) |
| Enumeration Date | 2019-09-24 |
| Last Update Date | 2022-04-08 |