| NPI | 1104277896 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601012658) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2025-01-16 |