| NPI | 1710212295 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9110375) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601005630) |
| Enumeration Date | 2009-10-16 |
| Last Update Date | 2022-07-21 |