| NPI | 1750816559 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2011029758) |
| 363L00000X Nurse Practitioner (Licence: MO 2011029758) | |
| Enumeration Date | 2017-04-29 |
| Last Update Date | 2017-10-11 |