| NPI | 1699766113 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601011220) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA03414) |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2023-01-03 |