| NPI | 1538481882 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 000762) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601005665) |
| Enumeration Date | 2010-02-26 |
| Last Update Date | 2015-03-31 |