| NPI | 1982110722 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MI 5601010532) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CO 0005225) |
| Enumeration Date | 2017-12-15 |
| Last Update Date | 2021-09-28 |