| NPI | 1891976304 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601006971) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA1095) |
| 363A00000X Physician Assistant (Licence: OH 50002705) | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2014-04-14 |