| NPI | 1174282586 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 00010-15496) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601010579) |
| Enumeration Date | 2021-12-13 |
| Last Update Date | 2025-07-29 |