| NPI | 1528317153 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601007695) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AS0400X Physician Assistant, Surgical (Licence: IL 085004402) | |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2018-09-04 |