| NPI | 1275644650 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 1501127) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 1073264) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2008-12-30 |