| NPI | 1548779580 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9111341) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601008292) |
| Enumeration Date | 2017-09-21 |
| Last Update Date | 2018-10-31 |