| NPI | 1578545497 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA051295) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 009813) |
| 363A00000X Physician Assistant (Licence: MI 5601002969) | |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2007-11-15 |