| NPI | 1366936973 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601010999) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.005578RX) |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2022-05-23 |