| NPI | 1578789962 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085003459) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110002215) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2019-02-08 |