| NPI | 1720330285 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MI 5601006512) |
| Enumeration Date | 2012-10-09 |
| Last Update Date | 2021-10-27 |