| NPI | 1174720700 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9113717) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601003582) |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2021-09-23 |