| NPI | 1154929016 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601010282) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2020-10-13 |
| Last Update Date | 2022-04-27 |