| NPI | 1609902063 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: MO 2006038714) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: IL 085.002927) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2021-02-09 |