| NPI | 1871921171 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 6415) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601006810) |
| 363A00000X Physician Assistant (Licence: MI 5601006810) | |
| Enumeration Date | 2013-10-23 |
| Last Update Date | 2017-03-03 |