| 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 | 2023-04-19 |