| NPI | 1710216502 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601005631) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA 58779) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2009-12-08 |
| Last Update Date | 2023-06-01 |