| NPI | 1962770917 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA08484) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601006203) |
| Enumeration Date | 2011-12-06 |
| Last Update Date | 2022-03-09 |