| NPI | 1972945467 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 085005321) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0003751) |
| Enumeration Date | 2013-07-24 |
| Last Update Date | 2015-08-18 |