| NPI | 1679909071 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 385004382) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601006761) |
| Enumeration Date | 2013-09-18 |
| Last Update Date | 2019-08-22 |