| NPI | 1548548993 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601007420) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC021) |
| Enumeration Date | 2011-08-02 |
| Last Update Date | 2016-07-01 |