| NPI | 1134129109 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IL 085-003172) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OH 50-00-2092) |
| 363AS0400X Physician Assistant, Surgical (Licence: MA PA6450) | |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2018-02-27 |