| NPI | 1982172755 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12774) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MN 12774) |
| Enumeration Date | 2018-11-09 |
| Last Update Date | 2022-01-12 |