| NPI | 1215286802 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-01554) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS T-03430) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2021-06-15 |