| NPI | 1972837383 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 15249) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 013608) |
| Enumeration Date | 2009-10-01 |
| Last Update Date | 2025-11-04 |