| NPI | 1447509252 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001006899) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601006447) |
| Enumeration Date | 2012-09-07 |
| Last Update Date | 2016-12-28 |