| NPI | 1104935303 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2006022546) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS t00749) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2012-12-31 |