| NPI | 1205116076 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085004071) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 52415) |
| 363A00000X Physician Assistant (Licence: NY 018509) | |
| 363A00000X Physician Assistant (Licence: MA PA5322) | |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2015-06-03 |