| NPI | 1306932132 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-10610) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601004820) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2022-03-15 |