| NPI | 1245506450 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA5313) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 15-01529) |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2024-03-18 |