| NPI | 1619566106 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.008838) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2023009300) |
| Enumeration Date | 2021-01-11 |
| Last Update Date | 2024-02-14 |