| NPI | 1104362383 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601008053) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601008053) |
| 363AS0400X Physician Assistant, Surgical (Licence: MA PA6066) | |
| Enumeration Date | 2017-01-12 |
| Last Update Date | 2020-10-23 |