| NPI | 1053834036 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601008912) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 4156-23) |
| Enumeration Date | 2017-07-20 |
| Last Update Date | 2019-04-17 |