| NPI | 1104255496 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MI 5601006722) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601006722) |
| Enumeration Date | 2013-11-06 |
| Last Update Date | 2026-07-01 |