| NPI | 1154911675 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601010382) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: IA 109264) | |
| 363AM0700X Physician Assistant, Medical (Licence: IA 109264) | |
| 363AS0400X Physician Assistant, Surgical (Licence: IA 109264) | |
| Enumeration Date | 2021-01-19 |
| Last Update Date | 2022-06-07 |