| NPI | 1306307616 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2019032243) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 15-02224) |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2022-04-13 |