| NPI | 1548651722 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2014036853) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 15-01959) |
| Enumeration Date | 2015-02-10 |
| Last Update Date | 2021-09-09 |