| NPI | 1639241268 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2004000621) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 85002158) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2021-07-26 |