| NPI | 1245752856 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.007362) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 4207-23) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-07-14 |
| Last Update Date | 2019-10-18 |