| NPI | 1568032183 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9114780) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601010613) |
| Enumeration Date | 2021-06-26 |
| Last Update Date | 2021-08-16 |