| NPI | 1164177572 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601012437) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.007476RX) |
| Enumeration Date | 2022-02-14 |
| Last Update Date | 2024-09-04 |