| NPI | 1639512791 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601011637) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9107043) |
| Enumeration Date | 2013-04-09 |
| Last Update Date | 2023-05-04 |