| NPI | 1487094751 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9107104) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601006679) |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2013-07-01 |