| 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 |