| NPI | 1366845323 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601008595) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 5859) |
| Enumeration Date | 2014-10-06 |
| Last Update Date | 2019-09-24 |