| NPI | 1649757949 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-02105) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2018034797) |
| 363A00000X Physician Assistant (Licence: NJ 25MP00723100) | |
| Enumeration Date | 2018-07-19 |
| Last Update Date | 2023-08-21 |