| NPI | 1588212500 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9115555) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601009786) |
| Enumeration Date | 2019-09-03 |
| Last Update Date | 2022-08-16 |