| NPI | 1699556811 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2023040432) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2023040432) |
| Enumeration Date | 2023-10-12 |
| Last Update Date | 2023-10-12 |