| NPI | 1255989919 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 108139) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.008296) |
| Enumeration Date | 2019-08-27 |
| Last Update Date | 2021-05-14 |