| NPI | 1619133014 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601005716) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 085.003251) |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2018-01-22 |