| NPI | 1861420341 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601001412) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 1722) |
| 363A00000X Physician Assistant (Licence: WI 2692-23,) | |
| 363A00000X Physician Assistant (Licence: AZ 4398) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2011-02-23 |