| NPI | 1730496001 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.003824) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 1730496001) |
| Enumeration Date | 2010-09-08 |
| Last Update Date | 2018-02-26 |