| NPI | 1578013397 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601007904) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9109996) |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2020-01-02 |