| NPI | 1306389374 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601009825) | 
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 020448) | 
| Enumeration Date | 2016-11-23 | 
| Last Update Date | 2025-05-20 |