| NPI | 1225659196 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601009921) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 2490) |
| 363AM0700X Physician Assistant, Medical (Licence: MI 5601009921) | |
| Enumeration Date | 2020-05-02 |
| Last Update Date | 2025-07-08 |