| NPI | 1215568589 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2021047186) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant, Medical (Licence: MO 2021047186) | |
| Enumeration Date | 2020-01-27 |
| Last Update Date | 2025-07-24 |