| NPI | 1992177679 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 13576) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 3685) |
| Enumeration Date | 2015-10-21 |
| Last Update Date | 2021-08-16 |