| NPI | 1902101611 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA058853) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.003954) |
| Enumeration Date | 2011-01-11 |
| Last Update Date | 2019-01-08 |