| NPI | 1942667498 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085007942) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096004258) | |
| Enumeration Date | 2016-01-27 |
| Last Update Date | 2023-12-08 |