| NPI | 1962025197 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9120945) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085008617) |
| 363AM0700X Physician Assistant, Medical (Licence: IL 085.008617) | |
| Enumeration Date | 2020-05-21 |
| Last Update Date | 2025-12-02 |