| NPI | 1164599130 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-09123) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601003443) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2024-03-14 |