| NPI | 1063930709 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AK 137079) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 15-02030) |
| Enumeration Date | 2017-09-01 |
| Last Update Date | 2019-03-02 |