| NPI | 1568412724 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 6063472-1206) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: UT 6063472-1206) |
| 363AM0700X Physician Assistant, Medical (Licence: IL 085.004349) | |
| 363AM0700X Physician Assistant, Medical (Licence: IL 385.003199) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2016-11-10 |