| NPI | 1588111074 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601008737) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 20087) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2019-03-01 |