| NPI | 1124012919 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601002814) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 5601002814) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2023-03-02 |