| NPI | 1467655506 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2019003486) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 15-00840) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2020-04-02 |