| NPI | 1457759276 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085007740) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-05357) |
| 363A00000X Physician Assistant (Licence: MI 5601007645) | |
| Enumeration Date | 2014-12-10 |
| Last Update Date | 2021-05-05 |