| NPI | 1083882617 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL 9114212) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601004530) |
| Enumeration Date | 2008-02-17 |
| Last Update Date | 2023-04-06 |