| NPI | 1992261671 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085010016) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2019-02-18 |
| Last Update Date | 2023-10-11 |