| NPI | 1376776831 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085005692) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601005578) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA056675) | |
| Enumeration Date | 2009-09-01 |
| Last Update Date | 2021-05-11 |