| NPI | 1306129374 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601006914) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA055169) |
| Enumeration Date | 2011-09-26 |
| Last Update Date | 2016-12-06 |