| NPI | 1407058936 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MI 5601005043) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 5601005043) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2013-01-16 |