| NPI | 1174045959 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: TN 5128) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 5128) |
| 363A00000X Physician Assistant (Licence: MI 5601008219) | |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2025-07-03 |