| NPI | 1619315611 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL PA.866) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601006632) |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2018-09-12 |