| NPI | 1629463492 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 54315) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601007329) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2020-10-11 |