| NPI | 1215181607 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601001825) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AL PA512) |
| Enumeration Date | 2008-11-11 |
| Last Update Date | 2021-03-30 |