| NPI | 1275846065 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601005794) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-04652) |
| Enumeration Date | 2010-07-21 |
| Last Update Date | 2017-08-03 |