| NPI | 1043039159 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IA 132130) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2024037710) |
| 363A00000X Physician Assistant (Licence: KS 15-02980) | |
| Enumeration Date | 2024-10-07 |
| Last Update Date | 2025-11-05 |