| NPI | 1164895108 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9109196) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601007551) |
| Enumeration Date | 2015-11-12 |
| Last Update Date | 2022-02-08 |