| NPI | 1699552018 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2024036848) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2023-09-11 |
| Last Update Date | 2024-09-17 |