| NPI | 1093110827 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085005639) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2014-0077) |
| Enumeration Date | 2014-10-22 |
| Last Update Date | 2023-08-11 |