| NPI | 1760999049 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MI 5601008426) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2018-01-08 |
| Last Update Date | 2019-10-03 |