| NPI | 1720029929 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 085-002512) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IN 10000812A) |
| 363AS0400X Physician Assistant, Surgical (Licence: WI 2695-023) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2014-01-07 |