| NPI | 1235685975 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2016024307) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 15-01899) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2016-09-01 |