| NPI | 1205945144 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2012017129) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 15-00777) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2021-01-25 |