| NPI | 1972552131 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.004757) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50-00-1216) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2021-03-09 |