| NPI | 1376808790 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2014009308) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085004437) |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2022-11-22 |