| NPI | 1063751592 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2021009627) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 9690) |
| 363A00000X Physician Assistant (Licence: KS 15-02488) | |
| Enumeration Date | 2013-02-04 |
| Last Update Date | 2023-06-22 |