| NPI | 1477521383 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 104203) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601007664) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2017-01-11 |