| NPI | 1063839520 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601010010) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.003982) |
| Enumeration Date | 2014-03-23 |
| Last Update Date | 2021-03-15 |