| NPI | 1578814976 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WI 3029) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WI 3029) |
| 363A00000X Physician Assistant (Licence: WI 3029) | |
| 363AS0400X Physician Assistant, Surgical (Licence: IL 385003967) | |
| Enumeration Date | 2012-09-25 |
| Last Update Date | 2015-12-11 |