| NPI | 1871505644 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601004121) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: MI 5601004121) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2016-06-09 |