| NPI | 1063790095 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 56406) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 085.004060) |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2019-05-22 |