| NPI | 1356001234 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601012397) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.007989RX) |
| Enumeration Date | 2021-12-20 |
| Last Update Date | 2024-09-05 |