| NPI | 1649788308 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601009667) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 20358) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2018-01-16 |
| Last Update Date | 2020-01-15 |