| NPI | 1780738823 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 9564) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601003291) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2020-03-25 |