| NPI | 1760727788 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 310523) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085.004574) |
| 363AS0400X Physician Assistant, Surgical (Licence: WI 310523) | |
| Enumeration Date | 2012-12-02 |
| Last Update Date | 2013-09-06 |