| NPI | 1205391042 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601009839) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 023163-1) |
| Enumeration Date | 2019-02-06 |
| Last Update Date | 2020-02-14 |