| NPI | 1063199198 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601012377) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NH 2082) |
| Enumeration Date | 2023-06-30 |
| Last Update Date | 2024-06-27 |