| NPI | 1912610163 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2024007412) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.010325) |
| Enumeration Date | 2023-01-03 |
| Last Update Date | 2025-06-13 |