| NPI | 1790851301 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 5638) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 385-001225) |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2021-12-21 |