| NPI | 1891843256 |
|---|---|
| Former Name | TINA WILHARM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 002058) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 96001980) |
| 363AM0700X Physician Assistant, Medical (Licence: IA 002058) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2020-07-13 |