| NPI | 1639656085 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-02568) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2018017096) |
| 363A00000X Physician Assistant (Licence: NY 022356-1) | |
| 363AM0700X Physician Assistant, Medical (Licence: CO PA.0005871) | |
| Enumeration Date | 2018-07-27 |
| Last Update Date | 2022-02-10 |