| NPI | 1720272875 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2010010437) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS T01514) |
| Enumeration Date | 2007-08-31 |
| Last Update Date | 2017-08-04 |