| NPI | 1255708343 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MI 998421) |
| 363AM0700X Physician Assistant, Medical (Licence: MI 5601007797) | |
| Enumeration Date | 2015-08-25 |
| Last Update Date | 2021-02-14 |