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 |