| NPI | 1194807859 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-01040) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2007008536) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2012-12-31 |