| NPI | 1366976300 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.007058) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601007912) |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2019-08-01 |