| NPI | 1215563390 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: AZ 9109) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 9109) |
| 363A00000X Physician Assistant (Licence: IL 085.007788) | |
| Enumeration Date | 2020-03-20 |
| Last Update Date | 2025-01-07 |