| NPI | 1356091862 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601012642) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 029131) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-27 |
| Last Update Date | 2024-12-23 |