| NPI | 1174662357 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2019005000) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 002489) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2019-03-08 |