| NPI | 1598079725 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MN 10842) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IL 085.003781) |
| Enumeration Date | 2010-07-29 |
| Last Update Date | 2010-12-01 |