| NPI | 1649835455 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2019003363) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.006942) |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2019-05-07 |