| NPI | 1508105099 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601007049) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 001003968) |
| Enumeration Date | 2013-02-04 |
| Last Update Date | 2016-01-28 |