| NPI | 1164512935 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601006698) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 3512) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2013-07-18 |