| NPI | 1679037584 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2020027400) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2019-01-24 |
| Last Update Date | 2020-08-31 |