| NPI | 1912328691 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MO 2013044925) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 15-01686) |
| Enumeration Date | 2013-12-23 |
| Last Update Date | 2014-03-16 |