| NPI | 1013161652 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601005667) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA05945) |
| 363AM0700X Physician Assistant, Medical (Licence: MI 5601005667) | |
| Enumeration Date | 2008-11-10 |
| Last Update Date | 2021-07-09 |