| NPI | 1487166906 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-08760) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601008408) |
| Enumeration Date | 2017-10-25 |
| Last Update Date | 2021-07-23 |