| NPI | 1164673836 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601008532) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 4313) |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2023-01-02 |