| NPI | 1972815819 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10738) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 1427) |
| 363AM0700X Physician Assistant, Medical (Licence: WI 4259) | |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2020-10-09 |