| NPI | 1528095973 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 1501358) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2005004536) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2014-03-05 |