| NPI | 1144716515 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601008943) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2018-0036) |
| Enumeration Date | 2018-07-09 |
| Last Update Date | 2023-05-31 |