| NPI | 1780992263 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MO 2011026869) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KS 15-01417) |
| Enumeration Date | 2010-09-19 |
| Last Update Date | 2018-03-17 |