| NPI | 1649397894 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2015040139) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: IL 085-001713) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2020-11-24 |