| NPI | 1497079164 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601005913) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA1336) |
| Enumeration Date | 2010-03-24 |
| Last Update Date | 2011-12-08 |