| NPI | 1083711865 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 1260) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601003452) |
| 363A00000X Physician Assistant (Licence: IL 85001446) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2014-05-06 |