| NPI | 1821544081 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601007905) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ mc4600816) |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2021-04-05 |