| NPI | 1952581142 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: MO 2017002393) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-003010) |
| 363AM0700X Physician Assistant Medical (Licence: OH 50.003099) | |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2023-12-21 |