NPI | 1306496872 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601011764) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA060969) |
Enumeration Date | 2019-09-17 |
Last Update Date | 2023-11-03 |