| NPI | 1043774821 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2019002770) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 15-02189) |
| Enumeration Date | 2019-01-26 |
| Last Update Date | 2025-10-07 |