| NPI | 1922483379 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601011234) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA11266) |
| 363AM0700X Physician Assistant, Medical (Licence: CO PA.0004333) | |
| Enumeration Date | 2015-07-28 |
| Last Update Date | 2022-12-27 |