| 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 |