| NPI | 1689142580 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-02209) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2018040346) |
| 363AS0400X Physician Assistant, Surgical (Licence: CA PA62385) | |
| Enumeration Date | 2018-11-08 |
| Last Update Date | 2025-11-20 |