| NPI | 1124562038 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601008631) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA058764) |
| Enumeration Date | 2016-12-12 |
| Last Update Date | 2022-10-20 |