| NPI | 1639387798 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601008922) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 004237) |
| Enumeration Date | 2007-05-20 |
| Last Update Date | 2019-06-06 |