| NPI | 1609992403 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 6793) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601004067) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2019-11-05 |