| NPI | 1619994068 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9109096) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601004388) |
| 363AS0400X Physician Assistant, Surgical (Licence: MI 5601004388) | |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2015-11-02 |