| NPI | 1194381723 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MI 5601009014) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5601009014) |
| Enumeration Date | 2019-05-20 |
| Last Update Date | 2019-10-16 |