| NPI | 1710996699 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: HI AMD-905) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601002933) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2020-03-27 |