NPI | 1760764609 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601006075) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9108870) |
Enumeration Date | 2011-09-16 |
Last Update Date | 2020-08-31 |