| NPI | 1912196544 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 085003709) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 2212-023) |
| 363AS0400X Physician Assistant, Surgical (Licence: WI 2212-023) | |
| Enumeration Date | 2007-10-19 |
| Last Update Date | 2015-07-02 |