| NPI | 1356900492 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2019009093) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.007591) |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2023-11-01 |