| NPI | 1255684965 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA111122) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 385.003207) |
| Enumeration Date | 2012-10-18 |
| Last Update Date | 2022-08-02 |