| NPI | 1649462342 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-01203) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2011-0035) |
| Enumeration Date | 2007-08-16 |
| Last Update Date | 2018-09-11 |