| NPI | 1780774091 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2021015115) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KS 1109) |
| Enumeration Date | 2006-10-15 |
| Last Update Date | 2021-07-20 |