| NPI | 1710728696 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2024011261) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085010221) |
| Enumeration Date | 2024-06-04 |
| Last Update Date | 2024-06-04 |