| NPI | 1821368853 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601008318) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: HI AMD450) |
| Enumeration Date | 2012-01-06 |
| Last Update Date | 2018-01-09 |