| NPI | 1891070694 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 13027) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 363AM0700X) |
| 363AM0700X Physician Assistant Medical (Licence: IL 085.004163) | |
| Enumeration Date | 2011-10-12 |
| Last Update Date | 2021-09-03 |