| NPI | 1821096074 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601004959) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OH 50-00-2063) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2008-10-06 |