| NPI | 1376932400 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.005217) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 3473-23) |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2022-06-27 |