| NPI | 1669404349 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: MI 5601004713) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant Medical (Licence: MI L775906) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2021-02-11 |