| NPI | 1013293489 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601009953) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-12748) |
| 363A00000X Physician Assistant (Licence: GA 11317) | |
| Enumeration Date | 2011-10-28 |
| Last Update Date | 2024-01-11 |