| NPI | 1548342322 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: KS 1500881) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MO 2006009291) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2007-07-08 |