| NPI | 1760895601 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: MO 2023000625) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: IL 085.005001) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2024-01-23 |