| NPI | 1912263344 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 085.005382) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601006229) |
| 363AS0400X Physician Assistant, Surgical (Licence: MI 5601006229) | |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2015-04-21 |