| NPI | 1528379302 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MI 5601005736) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MI 5601005736) |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2017-03-07 |