| NPI | 1548021264 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 209026546) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209.026546) |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 209.026546) | |
| Enumeration Date | 2024-01-19 |
| Last Update Date | 2024-10-01 |