| NPI | 1649242157 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 85-000927) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 000610) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2010-05-24 |