| NPI | 1275804668 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2011039551) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 1501508) |
| Enumeration Date | 2012-01-18 |
| Last Update Date | 2020-10-01 |