| NPI | 1265695530 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IL 085004128) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WI 2303) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2016-02-19 |