| NPI | 1710103908 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085004223) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 008559) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2020-01-10 |