| NPI | 1760436133 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: HI AMD- 297) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601001921) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2023-08-22 |