| NPI | 1356664346 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: WI 2541) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 2541-023) |
| 363A00000X Physician Assistant (Licence: IL 085-003712) | |
| Enumeration Date | 2010-03-05 |
| Last Update Date | 2015-04-21 |