| NPI | 1154889392 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2024003086) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 3746) |
| 363AM0700X Physician Assistant, Medical (Licence: MO 2024003086) | |
| Enumeration Date | 2019-03-06 |
| Last Update Date | 2025-09-16 |