| NPI | 1902996945 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9106059) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601004249) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2011-07-08 |