| NPI | 1053656116 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 002348) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IA 002348) |
| 363AS0400X Physician Assistant, Surgical (Licence: IA 002348) | |
| 363A00000X Physician Assistant (Licence: IL 085.004555) | |
| Enumeration Date | 2012-11-30 |
| Last Update Date | 2024-05-02 |