| NPI | 1962642744 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.004206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-01727) |
| Enumeration Date | 2009-03-06 |
| Last Update Date | 2023-11-28 |