| NPI | 1407196561 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001010965) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.004604) |
| Enumeration Date | 2013-02-26 |
| Last Update Date | 2021-12-08 |