| NPI | 1386973733 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5315091344) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 4590) |
| Enumeration Date | 2009-12-14 |
| Last Update Date | 2019-07-22 |