NPI | 1104061837 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085-005857) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601005440) |
Enumeration Date | 2008-12-09 |
Last Update Date | 2018-03-26 |