| NPI | 1669622791 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS T-02388) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2008029331) |
| Enumeration Date | 2008-09-25 |
| Last Update Date | 2015-02-16 |