| NPI | 1366910176 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601008870) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601008870) |
| 363AS0400X Physician Assistant, Surgical (Licence: MI 5601008870) | |
| Enumeration Date | 2018-11-09 |
| Last Update Date | 2020-05-18 |