| NPI | 1770047672 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-02868) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA61272396) |
| 363A00000X Physician Assistant (Licence: CO PA.0006331) | |
| Enumeration Date | 2019-01-24 |
| Last Update Date | 2024-01-25 |