| NPI | 1154505287 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 65701) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 363AM0700X Physician Assistant, Medical (Licence: IL 085.003048) | |
| Enumeration Date | 2007-12-26 |
| Last Update Date | 2020-11-10 |