| NPI | 1215969241 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601004557) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C03859) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2020-12-07 |