| NPI | 1790724011 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: MI 577469) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601002478) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2007-07-08 |