| NPI | 1063721264 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 2672) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.003935) |
| Enumeration Date | 2010-10-05 |
| Last Update Date | 2010-10-30 |