| NPI | 1679585434 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-05185) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601002530) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2014-11-25 |