| NPI | 1104432608 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601011959) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 736723) |
| Enumeration Date | 2020-09-20 |
| Last Update Date | 2025-09-22 |