| NPI | 1972382208 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 15522) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 8650) |
| Enumeration Date | 2023-09-26 |
| Last Update Date | 2025-10-03 |