| NPI | 1619351012 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2022032641) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MO 2014031793) |
| Enumeration Date | 2015-07-15 |
| Last Update Date | 2024-02-21 |