| NPI | 1063982973 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601009914) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10002631A) |
| Enumeration Date | 2018-12-04 |
| Last Update Date | 2023-11-27 |