| NPI | 1770571820 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 4872) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601003682) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2018-09-21 |