| NPI | 1427165794 |
|---|---|
| Doing Business As | |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 1703-023) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-001635) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2007-07-08 |