| NPI | 1720671738 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 085008439) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 5549) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-02-19 |
| Last Update Date | 2026-03-19 |