| NPI | 1902141104 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA055975) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601006520) |
| Enumeration Date | 2012-11-29 |
| Last Update Date | 2016-03-08 |