| NPI | 1487104303 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2019027949) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085005966) |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2019-08-23 |