| NPI | 1235361726 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.005036) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA06301) |
| 363A00000X Physician Assistant (Licence: CA PA21475) | |
| Enumeration Date | 2009-08-17 |
| Last Update Date | 2014-08-25 |