| NPI | 1134902679 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601012675) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 9866) |
| Enumeration Date | 2023-08-17 |
| Last Update Date | 2024-11-19 |