| NPI | 1467646711 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA01456) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601005028) |
| Enumeration Date | 2007-08-30 |
| Last Update Date | 2021-02-05 |