| NPI | 1245648344 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085005800) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 4010) |
| 363A00000X Physician Assistant (Licence: CT 23.003158) | |
| Enumeration Date | 2014-08-01 |
| Last Update Date | 2022-07-21 |