| NPI | 1245695287 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: MI 5601007621) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601007621) |
| Enumeration Date | 2015-12-17 |
| Last Update Date | 2025-03-21 |