| NPI | 1710157268 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085-002274) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA1032) |
| Enumeration Date | 2008-03-11 |
| Last Update Date | 2008-03-11 |