| NPI | 1912980533 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601004207) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 2251) |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2024-10-16 |