| NPI | 1336000504 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2026003575) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS Pending-123) |
| Enumeration Date | 2025-11-18 |
| Last Update Date | 2026-06-16 |