| NPI | 1154402378 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601011011) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 4963) |
| 363A00000X Physician Assistant (Licence: OH 50.001407RX) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2025-02-24 |