| NPI | 1073744751 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2021003796) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 002022) |
| 363AM0700X Physician Assistant, Medical (Licence: IL 085.005071) | |
| Enumeration Date | 2009-07-29 |
| Last Update Date | 2021-02-01 |