| NPI | 1174861405 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9110285) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601006555) |
| Enumeration Date | 2013-01-22 |
| Last Update Date | 2018-03-17 |