| NPI | 1285156307 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9111268) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601008220) |
| Enumeration Date | 2017-07-11 |
| Last Update Date | 2022-07-21 |