| NPI | 1144603721 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601007382) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 9108647) |
| 363A00000X Physician Assistant (Licence: NY 018640-1) | |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2015-07-01 |