| NPI | 1376865469 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601004206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.002446) |
| Enumeration Date | 2010-02-17 |
| Last Update Date | 2015-06-15 |