| NPI | 1174994461 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601008285) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA 9109110) |
| Enumeration Date | 2015-10-12 |
| Last Update Date | 2019-01-16 |