| NPI | 1669642955 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MI 5601005411) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601005411) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 012364) | |
| Enumeration Date | 2008-03-03 |
| Last Update Date | 2024-01-04 |