| NPI | 1619079167 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 1769) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 15-00971) |
| Enumeration Date | 2006-09-04 |
| Last Update Date | 2017-10-02 |