| NPI | 1518104314 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601011556) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 013066) |
| Enumeration Date | 2009-01-15 |
| Last Update Date | 2023-04-28 |