| NPI | 1598157026 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 171W00000X Contractor (Licence: IL 096003594) |
| 171W00000X Contractor (Licence: WI 1445-39) | |
| Enumeration Date | 2015-02-20 |
| Last Update Date | 2020-03-23 |