| NPI | 1619915196 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601001971) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MI 5601001971) |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2009-07-30 |