| NPI | 1174714372 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601005004) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MI 5601005004) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2016-01-19 |