| NPI | 1245993021 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-13122) |
| 363A00000X Physician Assistant (Licence: KS 15-02587) | |
| Enumeration Date | 2021-10-18 |
| Last Update Date | 2024-01-31 |