| NPI | 1598163172 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601001461) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 001461) |
| Enumeration Date | 2014-12-12 |
| Last Update Date | 2015-03-19 |