| NPI | 1073055356 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MI 5601007689) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 7806-23) |
| Enumeration Date | 2016-11-17 |
| Last Update Date | 2025-03-05 |