| NPI | 1174404172 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 138564) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 15-03163) |
| Enumeration Date | 2025-09-08 |
| Last Update Date | 2026-05-15 |