| NPI | 1528052750 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO PYA113653) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 15-00527) |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2024-12-11 |