| NPI | 1013192046 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.006881) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 00777) |
| Enumeration Date | 2008-01-09 |
| Last Update Date | 2021-03-02 |