| NPI | 1235101528 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MO 2003000103) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2003000103) |
| 363AS0400X Physician Assistant, Surgical (Licence: KS 15-00860) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2022-02-01 |