| NPI | 1588688147 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601005370) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 10112) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2022-10-07 |