| NPI | 1609930262 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601004257) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 6324) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2022-03-04 |