| NPI | 1972679512 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MO 2005028564) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KS 1500937) |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2007-07-09 |