| NPI | 1134588254 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601009211) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA OA003748) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA058111) | |
| Enumeration Date | 2016-02-17 |
| Last Update Date | 2019-05-09 |