| NPI | 1558426882 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601006279) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-002520) |
| 363A00000X Physician Assistant (Licence: WI 2100) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2022-05-13 |