| NPI | 1760886444 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085-005849) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-05289) |
| Enumeration Date | 2014-10-09 |
| Last Update Date | 2019-02-20 |