| NPI | 1578751053 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 4758) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601005143) |
| 363A00000X Physician Assistant (Licence: CO PA.0005764) | |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2019-04-11 |