| NPI | 1568916583 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 085008913) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 3881) |
| 363AS0400X Physician Assistant, Surgical (Licence: WI 3881-23) | |
| Enumeration Date | 2016-08-08 |
| Last Update Date | 2022-05-23 |