| NPI | 1912308727 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 12347157-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085005820) |
| Enumeration Date | 2014-09-11 |
| Last Update Date | 2022-04-05 |