| NPI | 1306579727 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601011279) |
| Enumeration Date | 2022-07-04 |
| Last Update Date | 2023-08-29 |