| NPI | 1053678557 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085005768) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA1716) |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2022-07-21 |