| NPI | 1306537634 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2023038572) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 15-02806) |
| Enumeration Date | 2023-05-17 |
| Last Update Date | 2023-10-11 |