| NPI | 1265099113 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MI 5601009234) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5601009234) |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2021-10-05 |