| NPI | 1134507940 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601007362) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MI 5601007362) |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2023-11-03 |