| NPI | 1912948183 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601006714) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9102559) |
| 363A00000X Physician Assistant (Licence: CT 002100) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2013-12-19 |