| NPI | 1356534572 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MT 86255) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601005012) |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2022-03-14 |