| NPI | 1619344249 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MT MED-PAC-LIC-68818) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KS T04368) |
| Enumeration Date | 2015-08-31 |
| Last Update Date | 2025-04-10 |