| NPI | 1952867731 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2020007934) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.007574) |
| Enumeration Date | 2019-02-16 |
| Last Update Date | 2020-07-28 |