| NPI | 1235130576 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601003704) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: ME PA001143) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2018-06-12 |