| NPI | 1023032596 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601004403) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 10095) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2018-10-01 |