| NPI | 1336864933 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601011299) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MI 5601011299) |
| Enumeration Date | 2022-10-05 |
| Last Update Date | 2023-10-17 |