| NPI | 1639354509 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9104877) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9104877) |
| 363AM0700X Physician Assistant, Medical (Licence: IL 085.003112) | |
| Enumeration Date | 2008-01-09 |
| Last Update Date | 2019-06-20 |