| NPI | 1154630762 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601006671) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 21112) |
| Enumeration Date | 2010-09-30 |
| Last Update Date | 2016-09-02 |