| NPI | 1205943859 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2007008414) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085002381) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2021-02-23 |