| NPI | 1164201703 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MI 5601013994) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110009777) |
| Enumeration Date | 2023-09-25 |
| Last Update Date | 2026-08-05 |