| NPI | 1134780794 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 5289) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601009837) |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2024-07-29 |