| NPI | 1114397353 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601011813) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 085.005597) |
| Enumeration Date | 2015-09-30 |
| Last Update Date | 2024-10-10 |