| NPI | 1972150936 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 14992) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-007130) |
| Enumeration Date | 2019-08-23 |
| Last Update Date | 2025-08-06 |