| NPI | 1477740744 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5601005430) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601005430) |
| 363AS0400X Physician Assistant, Surgical (Licence: IL 085.003037) | |
| Enumeration Date | 2007-10-01 |
| Last Update Date | 2010-06-28 |