| NPI | 1356056188 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IL 085.009437)  | 
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IN 10004851A)  | 
| Enumeration Date | 2023-01-17 | 
| Last Update Date | 2025-07-16 |