| NPI | 1366495665 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601003294) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.002011) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2007-07-08 |