| NPI | 1720036767 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.002495) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 1758-023) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2014-03-05 |