| NPI | 1619316767 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2023046482) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OK 15382) |
| 363A00000X Physician Assistant (Licence: OK 4488) | |
| 363A00000X Physician Assistant (Licence: KS 15-02858) | |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2024-01-19 |