| NPI | 1164096293 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601010487) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 5440-23) |
| Enumeration Date | 2021-05-13 |
| Last Update Date | 2022-11-21 |