| NPI | 1891450565 |
|---|---|
| Former Name | RILEY MAE FLAKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085009920) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2021-11-07 |
| Last Update Date | 2023-08-23 |