| NPI | 1023271632 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR PA195380) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085003524) |
| 363AS0400X Physician Assistant, Surgical (Licence: IL 085003524) | |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2023-01-10 |