| NPI | 1821147539 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601003061) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: IL 085003646) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2010-07-19 |