| NPI | 1225069008 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 54937) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601003475) |
| 363AM0700X Physician Assistant, Medical (Licence: MI 5601003475) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2018-03-13 |