| NPI | 1316602147 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601010723) |
| Additional Taxonomies | 261QR1300X Clinic/Center Rural Health |
| Enumeration Date | 2021-11-06 |
| Last Update Date | 2022-12-27 |