| NPI | 1619250768 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-01487) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2020039297) |
| 363AS0400X Physician Assistant, Surgical (Licence: KS 1501487) | |
| Enumeration Date | 2011-09-26 |
| Last Update Date | 2023-09-14 |