| NPI | 1063691053 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.005170) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 2198023) |
| Enumeration Date | 2007-10-26 |
| Last Update Date | 2020-01-31 |