| NPI | 1023369212 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085007968) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2012033522) |
| 363AM0700X Physician Assistant, Medical (Licence: MO 2012033522) | |
| 363AS0400X Physician Assistant, Surgical (Licence: MO 2012033522) | |
| Enumeration Date | 2012-09-27 |
| Last Update Date | 2021-06-11 |