| NPI | 1881879781 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CA 19555) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601005995) |
| Enumeration Date | 2008-01-09 |
| Last Update Date | 2016-09-11 |