| NPI | 1982641718 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IL 385001340) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 001634) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2007-08-30 |