| NPI | 1194729673 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-00535) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: KS 1500535) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2011-01-14 |