| NPI | 1114642139 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MI 5601012884) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OH 50.007846RX) |
| Enumeration Date | 2022-10-12 |
| Last Update Date | 2025-04-09 |