| NPI | 1407181647 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL 9110417) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601005628) |
| Enumeration Date | 2009-10-06 |
| Last Update Date | 2019-04-23 |