| NPI | 1508115965 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601006446) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI L2304186) |
| Enumeration Date | 2012-08-31 |
| Last Update Date | 2016-03-21 |