| NPI | 1386402154 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MO 2024007391) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2024007391) |
| Enumeration Date | 2024-03-07 |
| Last Update Date | 2025-03-09 |