| NPI | 1912376856 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085006681) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 363A00000X) |
| Enumeration Date | 2015-09-22 |
| Last Update Date | 2022-05-21 |