| NPI | 1922474824 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601012252) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 085.005583) |
| Enumeration Date | 2015-08-13 |
| Last Update Date | 2024-04-29 |