NPI | 1679859300 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601008140) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2019022166) |
Enumeration Date | 2011-10-26 |
Last Update Date | 2024-11-06 |