| NPI | 1972608503 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: KS 1500707) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 15-00707) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2011-12-15 |