| NPI | 1265802623 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601007483) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110009956) |
| Enumeration Date | 2015-09-29 |
| Last Update Date | 2024-04-08 |