| NPI | 1588784920 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 5076) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601002821) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2013-06-06 |