| NPI | 1104055789 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: MI 5601005512) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2009-07-05 |
| Last Update Date | 2022-09-01 |