| NPI | 1548455744 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601005164) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2009-01-13 |