| NPI | 1245565076 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601005542) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.002961) |
| Enumeration Date | 2009-10-13 |
| Last Update Date | 2019-06-26 |