| NPI | 1588648182 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601004252) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OH 50002389) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2014-01-22 |