| NPI | 1174810667 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MI 5601006254) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 006100) |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2023-02-02 |