| NPI | 1053415588 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601003625) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 010962-1) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2007-10-27 |