| NPI | 1255328894 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: FL PA9108081) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601001406) |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2015-08-13 |