| NPI | 1063639524 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA54144) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KS 961) |
| 103TC0700X Psychologist, Clinical (Licence: MO PY01796) | |
| 1041C0700X Social Worker, Clinical (Licence: MO SW001771) | |
| 363A00000X Physician Assistant (Licence: KS 15-01466) | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2020-02-20 |