| NPI | 1114220704 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601008166) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 21298) |
| Enumeration Date | 2010-12-21 |
| Last Update Date | 2017-05-10 |