| NPI | 1053974238 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2019008169) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085007014) |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2024-01-23 |