| NPI | 1497069694 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2012008168) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.003797) |
| Enumeration Date | 2010-07-29 |
| Last Update Date | 2018-10-18 |