| NPI | 1487627733 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601005457) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 010560-1) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2020-12-18 |