| NPI | 1861623951 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA07856) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085003389) |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2019-01-08 |